Provider Demographics
NPI:1700282449
Name:YANCHULEFF, THEODORE THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:THOMAS
Last Name:YANCHULEFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 FOLLINS CT
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-2131
Mailing Address - Country:US
Mailing Address - Phone:717-545-2437
Mailing Address - Fax:717-545-2437
Practice Address - Street 1:2501 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1904
Practice Address - Country:US
Practice Address - Phone:717-782-2372
Practice Address - Fax:717-782-2360
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003294L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist